Emergency Department Crowding is Harder to Solve: The Impact of COVID-19 of Longer Length of Stay

Objectives To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the length of stay (LOS) and prognosis of patients in the emergency department (ED). Methods A retrospective review of case data of patients in the ED during the early stages of the COVID-19 pandemic in the First Affiliated Hospital of Soochow University (January 15, 2020– January 14, 2021) was performed and compared with that during the pre-COVID-19 period (January 15, 2019 – January 14, 2020). Patient information including age, sex, length of stay, and death was collected. Wilcoxon Rank sum test was utilized to compare the difference in LOS between the two cohorts. Chi-Squared test was utilized to analyze the prognosis of patients. The LOS and prognosis in different departments (emergency internal medicine, emergency surgery, emergency neurology, and other departments) were further analyzed. Results Of the total 8278 patients, 4159 (50.24%) were ordered in the COVID-19 pandemic group and 4119 (49.76%) were ordered in the pre-COVID-19 group. The length of stay prolongs significantly in the COVID-19 group compared with that in the pre-COVID-19 group(13h vs 9.8h; p < 0.001). There was no significant difference in mortality between the two cohorts (4.8% VS 5.3%; p=0.341). Conclusion The COVID-19 pandemic was associated with a significant increase in the length of stay, which may lead to emergency department crowding. And the influence of the COVID-19 pandemic on patients in different emergency departments is different. There is no significant impact on the LOS of emergency neuropathy. Across departments, COVID-19 didn’t have a significant impact on the prognosis of ED patients.

Vestibular vertigo in emergency neurology

The review deals with approaches to the differential diagnosis of the causes of vertigo in emergency neurology. The main causes of episodic and acute vestibular syndrome are discussed. Clinical diagnostic methods for acute vestibular syndrome (evaluation of nystagmus, test of skew, head-impulse test and neurological status) are considered. Clinical signs of “benign” acute vestibular syndrome and symptoms indicating a stroke in the vertebrobasilar system are presented. Differential diagnostic criteria for peripheral and central vestibular disorders are presented. Transient ischemic attacks, features of the otoneurologic status in vestibular neuronitis and different localizations of cerebral infarction focus are considered. Errors in the diagnosis of the vertigo causes are discussed.

Neurohospitalist Practice and Well-Being During the COVID-19 Pandemic

Background and Purpose: Neurohospitalists play an important role in, and have been variably affected by, the ongoing COVID-19 pandemic. In this study, we survey neurohospitalists to characterize practice changes and the impact of the pandemic on their well-being. Methods: A 22-item survey was distributed to neurohospitalists through the Neurohospitalist Society and the American Academy of Neurology Neurohospitalist, Stroke & Vascular Neurology, and Critical Care & Emergency Neurology Sections. Results: After 2 weeks of collection, 123 responses were received, with 57% of respondents practicing in academic settings, 23% in private practice, and 7% in community hospitals. A minority of neurohospitalists (8%) were redeployed to care for COVID-19 or non-COVID-19 medicine patients. The most common neurologic diagnoses they reported in COVID-19 patients were delirium (85%), cerebrovascular events (75%), and seizure (35%); however, most neurohospitalists (59%) had evaluated fewer than 10 patients with COVID-19. Respondents observed that fewer patients with unrelated neurological diseases were admitted to the hospital compared to before the pandemic. Neurohospitalists experienced changes in administrative (27%), educational (15%), and research duties (11%), and had overall worse well-being and work-life balance (77%). Conclusions: The most common neurologic diagnoses seen in COVID-19 patients by neurohospitalists in this sample are delirium, cerebrovascular disease, and seizure. Though the majority of survey respondents reported not being primary frontline providers, they report key clinical and operational roles during the pandemic, and report worse well-being as compared to before the pandemic. Our data suggests that there are opportunities to improve neurohospitalists’ experience through flexible work practices and providing family care support.

Emergency Neurology

Neurological emergencies, either presenting in the emergency department, arising in hospitalized patients, or presenting in the field are among the most worrisome of all medical situations. Neurologists are trained in best approaches to these emergencies, which include such diverse presentations as severe headache, transient neurologic deficits, altered consciousness and coma, severe vertigo and balance problems, uncontrolled seizures, radicular and facial pain, and posttraumatic conditions. However, as time is often “the enemy” as ER physicians commonly say, diagnostic and treatment dilemmas are particularly challenging in the field of emergency neurology. This volume attempts, as do all the offerings in Oxford University Press’s What Do I Do Now series, to present straightforward but thorough roadmaps for handling the most common and worrisome impasses faced by neurologists and other providers in the topic area. Illustrative cases in cerebrovascular, epileptic, infectious, inflammatory, metabolic, traumatic, neoplastic, and structural conditions are presented with recommendations for best approaches to differential diagnosis, diagnostic testing, and management decision-making in important challenges faced in both adult and pediatric cases. Each case contains a brief summary of key information. The reader is encouraged to imagine the case under discussion, formulate a differential diagnosis, plan diagnostic testing, and begin thinking about best management approaches. Then read Drs. LaHue’s and Levin’s approach to the situation. At the end of each chapter is a list of key points to remember in the topic and a selection of resources for further reading.

Study on the Causes and Countermeasures of Medical Complaints during the Outbreak of Novel Coronavirus Disease

To investigate the medical complaints status and coping styles during the outbreak of the novel coronavirus diseases. Methods: 86 cases medical complaints of uninfected novel coronavirus disease, which collected from one hospital at Beijing city during the January-March 2020, have been retrospectively analyzed. The number, types and causes, department distribution have been evaluated at different stages. Results: During the epidemic, medical complaints are still one of the severe problems faced by hospitals, the number of medical complaints, was significantly higher than those during the non-epidemic, Emergency, Neurology and Neurosurgery were as the top three departments. Failure to admission to hospital as scheduled or as expected was an important and special reason in the medical complaints. Most of medical complaints were gain understanding and cooperation by effective communication, only 4 cases of complaints were application for Legal mediation procedure legal. Conclusion: Medical complaints during the outbreak is a serious problem facing by hospitals, which should be given the necessary attention and positive response to reduce the risk of related medical litigation cases at post-epidemic stage.

Assessment of nursing care-associated predictors of in-hospital mortality in the patients with acute ischemic stroke

Background/Aim. Stroke remains one of the leading causes of death and disability worldwide. The aim of the study was to determine the nursing care-associated predictors of in-hospital mortality in the patients with acute ischemic stroke (AIS) who were hospitalized at the Department of Emergency Neurology. Methods. Prospective cohort study included 59 consecutive patients with AIS admitted to the Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Belgrade. The patients were followed until discharge or death. For exploring a relationship between the outcome of patients with AIS and different groups of factors, the univariate and multivariate Cox proportionate hazard regression models were used. Results. There were 32 male and 27 female patients with AIS. The mean age was 62.5 ? 15.2 years. The average duration of hospitalization was 11.1 ? 9.6 days (median 8 days; range 1?54 days). Almost 80% of patients (47/59; 79.7%) were admitted to the stroke unit, while 12 (20.3%) patients were admitted to the intensive care unit. In the univariate Cox regression analysis the significant variables (p < 0.05) were the Morse score (p = 0.030) and the type of admission unit (p = 0.029). The multivariate predictive model revealed that the type of admission unit (stroke unit vs conventional unit) [hazard ratio (HR) = 0.16; p = 0.032] was the independent predictor of in-hospital mortality in the patients with AIS. Conclusion. The results of this study showed an important role of nursing staff in the recovery of the AIS patients, as well as that admission to the stroke units versus the conventional units is the independent predictor of decreased in-hospital mortality.